Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space.
Andy also writes often for O'Reilly's Radar site (http://oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

The previous section of this article looked at advances in health care, as well as some warnings about their efficacy at the Connected Health Conference. In sessions about experiments in altering care, people managing the new programs stressed that commitment and expertise are not enough; these programs call for structural and culture change within organizations. One speaker pointed out that quality programs must assess not just an individual clinician, but the whole system that intervenes in patient care.

In its 12th year, the Connected Health Symposium is more successful than ever: the most attendees, most exhibitors, and biggest sponsorship ever. More to the point, I noticed more sessions this year focusig on immediate, practical logistics of getting new programs in place. But a number of adoption issues remain:

Many pilot programs weren’t designed to be sustainable and scalable; even when successful, they weren’t adopted by the larger organization. Some speakers blamed these dead ends on a lack of an individual champion, others on the lack of organizational structures for promoting change.

Payers expect to see a return on investment within three years, but patients take much longer to show benefits of health. This isn’t rational. One speaker pointed out that while an insurer’s patients will move on, it will gain new patients that another insurer invested in. So a long-term investment will raise all boats. However, the fossilized financial models remain in place

Cost savings can slip away from you. Robert Perl, executive director and CEO of The Permanente Medical Group, reported that the use of electronic health records at Kaiser Permanente improved care but did not lower costs. The savings all went into the very expensive EHR itself, as well as the extra time physicians had to spend entering data because of the EHR’s design. But Kaiser chose to install Epic, so one could ask Dr. Perl why he expected the outcome to be any different.

It’s also disheartening to hear visitors from other countries. One would think that Britain and Canada, with their more broadly designed health care systems, would have solved the problems with data exchange and cost control that the U.S. struggles with. But reports suggest they’re just as bad off. The Canadian speaker said that after his PCP retired, no records were sent to his new one. Britain’s integration data efforts are still a “work in progress,” according to Anne Avidon, Head of Global Health Innovation at the Life Sciences Organisation of UK Trade & Investment. South Africa is also lagging on interoperability and data exchange. Semih Sen, a health care executive from Abu Dhabi, pointed out that “health care is the only industry left that isn’t global” and suggested some reforms, such as cross-border licenses.

My impression, overall, is that strides are being made in using data, engaging with individuals around their health needs, and providing innovative treatment options–but mostly outside the traditional institutions of health care. Those institutions are still trying to figure out how to achieve the organizational change that can permit them to participate in the health care revolution. And some are pouring money into experiments that they eventually abandon or can’t get financial benefit from because the environment is against them.